VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
46,870MODERNA
532GLAXOSMITHKLINE BIOLOGICALS
353PFIZER\BIONTECH
231MERCK & CO. INC.
221UNKNOWN MANUFACTURER
62SEQIRUS, INC.
25DYNAVAX TECHNOLOGIES CORPORATION
13EMERGENT BIOSOLUTIONS
12SANOFI PASTEUR
9NOVARTIS VACCINES AND DIAGNOSTICS
5PFIZER\WYETH
5PAXVAX
2TEVA PHARMACEUTICALS
2PROTEIN SCIENCES CORPORATION
1BERNA BIOTECH, LTD.
1INTERCELL AG
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL1,906
1,575
289
IMM209286
252
236
229
s029456178
171
UT7065MA166
155
149
145
S034636133
107
U62828AA103
100
98
P10025327596
U6737AA85
UJ446AA79
78
78
59
57
4BH3254
4F47253
52
27656352
50
PP9L548
49TM346
42
40
38
MENVEO38
4F47237
R1B252M36
34
C5763AA30
93362229
25
300057A24
UNK24
22
CW311621
18
17
15
UH894AB15
3Y7NL12
R1B743M12
EJ168611
el128410
10
10
10
9
ARBA141A9
UNK9
8
UNK8
8
1F4EB8
Unknown7
7
No batch number6
5
5
UJ090AA5
5
5
4
4
4
UNK4
JEV18K95E4
UNK3
A115A3
Z127A3
3
3333324181073
2
2
2
TAR352
1
1
1
1
1
A739081
1
1
1
1
1
037K20A68,542
EL128447,700
133

Incidents per State

State Total
15,185
CA14,096
NY7,507
TX7,196
FL6,939
IN5,527
PA4,560
IL4,179
OH4,054
AZ3,856
MI3,771
NJ3,411
MA3,278
VA3,208
NC3,114
WA3,034
GA2,864
MD2,652
MN2,534
CO2,532
WI2,457
MO2,029
OR1,943
TN1,715
CT1,693
KY1,603
OK1,226
AL1,201
KS1,162
IA1,157
SC1,106
NM1,065
UT973
AR951
LA945
NE829
NV797
ME795
MT789
NH756
ID674
AK661
WV661
PR650
MS585
HI536
RI510
VT441
SD361
ND356
DE350
DC239
WY209
GU32
AS16
VI13
MP9
MH3
FM2
QM1
XB1

ID: 1070034
Sex: M
Age: 72
State:

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: At administration the provider reported that the syringe leaked all of most of the dose out. It was determined that the patient l received little or no dose, so a new dose was given.

Other Meds:

Current Illness:

ID: 1070035
Sex: M
Age: 36
State: MI

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Can?t afford them

Allergies: None

Symptoms: SEVERE breathing difficulty and EXTREME fatigue to the point of needing emergency medical care but can?t afford it so...

Other Meds: None

Current Illness: None

ID: 1070036
Sex: F
Age: 67
State: GA

Vax Date: 02/04/2021
Onset Date: 02/12/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: betadine, iodine, potatoes

Symptoms: Adverse event is constant ringing in ears and continuous headache.

Other Meds: carvedilol, levothyroxine, losartan, atorvastatin calcium, asprin, calcium fish oil, vit C, multi vitamin, cinnamon, biotin, vit D3, echinacea, apple cider vinegar tablet, garlic tablet

Current Illness: none

ID: 1070037
Sex: F
Age: 72
State: OK

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: NA

Allergies: Sulfa, Percocet, Doxepin

Symptoms: Injection site: Soreness, raised (welt-like) and red area about the size of a silver dollar,

Other Meds: Levothyroxine 75 mcg, Vitamin B-6 100mg, Vitamin C 500mg, Turmeric 450 mg, N-Acetyl-L-Cysteine 600 mg, Hydroxychloroquine 200mg, Diclofenac Sodium Topical Gel 1%, Glucosamine Sulfate 1000mg, Omega 3 (Wild Alaskan Salmon Oil) 1000mg, Naproxe

Current Illness: NA

Date Died: 01/22/2021

ID: 1070038
Sex: M
Age: 68
State: HI

Vax Date: 01/14/2021
Onset Date: 01/22/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Unknown

Allergies: No known allergies

Symptoms: Client passed away 8 days after being vaccinated. It is unknown if it occurred from the vaccine or other comorbidities.

Other Meds: Plavix Aspirin Lisinopril Diazepam Morphine Sulfate Lyrica Spiriva Respinate Proair Air

Current Illness: COPD

ID: 1070039
Sex: F
Age: 86
State: OH

Vax Date: 01/22/2021
Onset Date: 02/09/2021
Rec V Date: 03/03/2021
Hospital: Y

Lab Data: 2/15 urinalysis done day PTA +large LE, >180 WBC per HPF, 19 RBC per HPF 2/16 Nasal PCR + Sars-CoV-2, negative influenza A/B, 2/16 WBC 14.4, Hgb 10.6, HCT 31.8, plt 149, Na 130, K+ 3.4, Cl 91, bicarb 24, Cr 2.87, BUN 54, glucose 330, BNP 8,218, troponin 46

Allergies: Levofloxacin PCN SMX-TMZ NSAIDs Erythromycin

Symptoms: Patient with 3-7 days of weakness. Hospitalized 2/16-2/20 for fever weakness and SOB. Diagnosed with COVID-19 and UTI. Did require O2 per NC briefly. Was treated with IV/PO dexamethasone and IV/PO Cipro Discharged to home

Other Meds: Elavil 50mg QHS Eliquis 2.5mg BID Biotin Refresh eye gtts Plavix 75mg QD Restasis eye gtts Flonase NS 2sprays each nares QHS glimepiride 2mg QD glucosamine-chondroitin TID levothyroxine 75mg daily loratadine 10mg QD metoprolol 50mg BID mon

Current Illness:

Date Died: 02/24/2021

ID: 1070040
Sex: F
Age: 71
State: MD

Vax Date: 02/10/2021
Onset Date: 02/22/2021
Rec V Date: 03/03/2021
Hospital: Y

Lab Data:

Allergies: Morphine

Symptoms: Admitted to hospital 2/22/21

Other Meds: Duloxetine, LIsinopril/Hctz, Oxycodone 10/325, Gabapentine 600

Current Illness: Thyroid nodule

ID: 1070041
Sex: F
Age: 79
State: PA

Vax Date: 02/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: Penicillin, Cephalosporins, Latex, IVP dye

Symptoms: Severe Headache on February 5th and nausea, headache, and the feeling that I would faint if I stood on the 6th. I checked my BP and it was 128/70. My blood sugar was 80. The symptoms passed by the 7th of February (my 80th birthday).

Other Meds: Benazepril, Metoprolol, HCTZ, Metformin, Actos, Lantus, Synthroid, Vitamin B12, Vitamin C, Vitamin D3, Multivitamin, Calcium + D, Loratadine, FeSO4, Magnesium, Biotin

Current Illness: None.

ID: 1070042
Sex: M
Age: 58
State: PA

Vax Date: 01/04/2021
Onset Date: 01/18/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Blood work normal, CAT scan indicated enlarged lymph nodes in the neck and chest

Allergies: none

Symptoms: About two weeks after receiving the vaccine the lymph nodes in my neck began to swell. I was put on amoxicillin for 20 days. When the swollen nodes didn't get better i was sent to a ER and Thoraxic Surgeon. I will be getting a biopsy on 3/5/2021.

Other Meds: amlodipine, losartan, spirolactin, phenofibrate

Current Illness: none

ID: 1070043
Sex: F
Age: 70
State: NJ

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: not aware of any

Symptoms: The patient is an idd resident and while administering the shot pulled her arm away forcefully and some leaked out. I spoke with Moderna on the phone, she said that if 50 percent or more was administered that we do not need to revaccinate. All 3 people agreed that more than 50 percent was administered so we did not revaccinate per the company direction.

Other Meds: do not know

Current Illness: not aware

ID: 1070044
Sex: F
Age: 74
State: CT

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient was asked pre-screening questions and answered "no" to receiving another vaccine in the last 14 days. Her sister was in the treatment station next to her and they both had received the tetanus vaccine on 2/25/21. When she went to make sure her sister answered "yes" to that question, the vaccine was already given. It was then found out patient is confused and would not have remembered receiving the tetanus vaccine.

Other Meds:

Current Illness:

ID: 1070045
Sex: F
Age: 55
State: IN

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Patient received vaccination. Approximately 12 minutes following vaccination, patient complained of shortness of breath, chest pain, and weakness. Had some burning in the left, upper chest. Vital signs were stable throughout episode. EMS onsite. Baseline EKG normal. Patient requested transport to ED. Transported via EMS.

Other Meds:

Current Illness:

ID: 1070046
Sex: F
Age: 39
State: PA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: Synthroid Levothyroxin

Symptoms: As I was driving home from vaccine I first noticed blurry vision, then extreme dizziness. My hands were trembling and heart started racing. A sensation like I was going to pass out came over my body. I never did pass out. All symptoms subsided within 20 minutes except the dizziness.... that persisted for about 1.5 hours . EXTREME dizziness. Tingly lips 8 hours later.

Other Meds: Armour Thyroid Aderall Wellbutrin Pristique

Current Illness: None

ID: 1070048
Sex: F
Age: 77
State: WA

Vax Date: 01/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Chills, 2 degrees of fever, sore arm, whole body ache, disoriented when walking & (collapsing pain in left leg when trying to stand the next morning), slept for 30 hours except for necessaries, didn't eat for 1 1/2 days, all in all body felt like a bad case of the flu.

Other Meds:

Current Illness:

ID: 1070049
Sex: F
Age: 17
State: CA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None

Allergies: NKA

Symptoms: 17 year old female arrived at clinic today to receive first dose of Moderna COVID-19 Vaccine. Patient and patient's mother unaware of age guidelines for Moderna Vaccine (18+). Patient able to apply for appointment via Prep Mod due to profession. Patient is an active health worker falling within tier based on profession, not meeting age requirements for vaccine. Patient received Moderna vaccine on left deltoid Lot # 013A21A Expiration date 04/02/2021. No adverse reactions noted at this time. Appropriate patient education provided to patient and parent regarding strict age parameters for COVID-19 vaccine. Patient and patient's mother verbally acknowledged understanding of Moderna age requirements.

Other Meds: None

Current Illness: None

ID: 1070050
Sex: F
Age: 47
State: VA

Vax Date: 01/20/2021
Onset Date: 01/21/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: COVID tests - negative - tested twice a week at work

Allergies: Kephlex - hives; lactose -intolerant; can't handle any red or blue dyes - digestive issues Raw pineapple - digestive; honey bees - nausea/fatigue/swollen in that area and tongue felt swollen

Symptoms: The first day, I had fatigue (tiredness) and little bit of soreness in the arm of the injection. It was later on that night that I had to use my other arm to get my arm up to a cabinet to reach something. I went to bed early. The next day, still very fatigued, I still had the soreness in the muscle in the injection site arm. 10:30 am at work - it hit me almost like a flu - really quick that I started to feel very bad. Headache - light a migraine - it encompassed my whole head and started having low grade fever and severe nausea and abdominal pain and chills and severe body aches and bone achiness. Extreme fatigue. Side that I got the vaccine in, the glands in my neck and under my arm were swollen. My fever was never only 100 - but 99.6 is where it usually ran and that was unusual for me to have a fever that high. I had had shingles about two years ago that affected my left side. I started to feel like my shingles was coming back. This felt like it was going to go from trunk all the way up to my neck (the shingles) - it didn't. I did have a few areas on my trunk area on that left side that did start - like a burning pain - no itchiness but they did go away. I had flushing feeling - it was worse than a hot flash and different - it was like my body was extremely hot. My coworkers told me that I looked red as a bright red apple - and I wear makeup and had a face mask on. That continued for about 5 days - face, cheeks, especially below my chin, neck and my trunk - just really red. I have a photo of it. There was no pain to it - just hot flushing feeling. That was different from the shingles. The headache never went away - seven days - had trouble sleeping it was painful. It was almost like I had flu. I had also increased aura migraines - this aura was squiggly lines instead of usual round. I felt like my chest was tight over the weekend. Like it might be going to my chest - Pulsometer - I check my pulse and my blood oxygen level - it went down to about 92 or 94% and I felt a little short of breath and that lasted about two days. I did not check my blood pressure. The only other thing, like if you have the flu for ten days etc which is what my symptoms lasted- but the fatigue lasted another week past these severe intense reactions.

Other Meds: Faraquel 50 mg daily; Clonosopan .5 mg - 1 daily; Estradiol .1 mg patch; Provera - 5 mg; melatonin - 3 mg at night; multi-vitamin

Current Illness: Slight cold in between both vaccines (dr visit - January 4th or 5th). Checked for flu - negative; COVID - inconclusive and work COVID test and that was negative

Date Died: 01/15/2021

ID: 1070051
Sex: F
Age: 79
State: TX

Vax Date: 01/06/2021
Onset Date:
Rec V Date: 03/03/2021
Hospital:

Lab Data: unknown

Allergies: Unknown

Symptoms: unknown

Other Meds: Gabapentin, Pennsaid, Carbidopa-Levodopa

Current Illness: HTN, Aortic Valve Disorder, Coronary Atherosclerosis of Native Coronary Artery, Hyperlipidemia, Aortic aneurysm

ID: 1070052
Sex: F
Age: 45
State: MO

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: CBC with diff; metabolic panel. Given Ativan 0.5 mg tab by mouth.

Allergies:

Symptoms: Patient was administered the Moderna vaccine at 1325 and was instructed that she needed 30 minutes of observation. At ~1335 patient left the building- reporting that she could not breath in her mask and was found on sidewalk outside. Patient was placed on a stretcher and vital signs were obtained [BP 94/62, HR 90, RR 26], anxious oriented x4. Visible muscle twitching/spasms of face then extending to limbs. Transported to ED via ambulance. Patient was evaluated and monitored in the ED. Patient continued to have mild twitching in upper extremities. Patient was treated and discharged.

Other Meds:

Current Illness:

ID: 1070053
Sex: F
Age: 39
State: CA

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Client has NKDA, stated allergic to cats

Symptoms: Client c/o a nerve discomfort from the vaccine site to the side of Left neck up to the jaw area. Advised client for another 15 minutes of observation. Client stated OK. NP was made aware and NP spoke with client. BP was taken at 146/84. Ox at 98% HR at 76, temp 98.7. Client was monitored for another 15 minutes BP was taken 10 minutes later with 143/83, Ox at 98, HR 75. Patient stated that she is okay. stated that the nerve discomfort is no longer present. Client left clinic stable with steady gait.

Other Meds: Client denies taking any prescription

Current Illness: None

ID: 1070054
Sex: F
Age: 78
State: CA

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: s/p vaccine c/o mild shortness of breath

Other Meds:

Current Illness:

ID: 1070055
Sex: F
Age: 66
State: OH

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Severe headache 10/10, nausea, vomiting, temp of 99 degrees F x 24 hours. waning at this time

Other Meds:

Current Illness:

ID: 1070056
Sex: F
Age: 73
State: NY

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: labored breathing, difficulty swallowing, hoarseness, pressure at base of throat

Other Meds:

Current Illness:

ID: 1070057
Sex: F
Age: 75
State: OH

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Blood panel 2/23/2021 results normal levels

Allergies: Sulfur

Symptoms: Terrible Itching under left armpit, then underarm, arm swelled , turned bright red and arm itched, hand swelled; moved to right underarm, itching, turned bright red and swelled; torso swelled, turned red, looked like a sun burn; finally neck and face turned red, swelled. Took on 12.5lbs of fluids. Physician prescribed steroids', Claritin and Benadryl; Swelling was gradual over a three week period. Just completed steriod treatment and had Physician follow-up, body fluid down, still a little on left side and toroso

Other Meds: Losartan, Vit. D, Estradiol, & Macula30+

Current Illness: None

ID: 1070058
Sex: M
Age: 51
State: MS

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: NONE

Allergies: no known allergies

Symptoms: ANGIOEDEMA OF LIPS

Other Meds: LISINOPRIL PIOGLITAZONE SINVASTIN ALBUTEROL INHALER VIT D CETIRIZINE

Current Illness: POSITIVE COVID 1/25/21

ID: 1070059
Sex: F
Age: 45
State: CA

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: none on file

Symptoms: Pt lost consciousness, fell to floor from seat shortly after receiving 2nd dose of Moderna. Pt assessment was done, vitals were taken. Pt was alert and oriented x4 when she regained consciousness, denied any neck/back pain. Reported h/o migraines, denies other past medical history. Pt sustained small cut to the bridge of her nose. Pt was transferred to wheelchair where she lost consciousness again for approx 10 seconds. RN supervisor called 911. Staff monitored pt until ambulance arrived. Pt was transported to ER.

Other Meds: denies meds

Current Illness:

ID: 1070060
Sex: M
Age: 67
State: TX

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: went to the er they say it was germ

Allergies: PNU MILK

Symptoms: shorten of breath burinng eyes heachache chest pain throwing up

Other Meds: Ibuprofen tylenol Emetrol

Current Illness: was exposed to kids stomach virus at the time of shot

ID: 1070061
Sex: F
Age: 23
State:

Vax Date: 02/24/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: none

Allergies: none

Symptoms: pain at the injection site and entire arm 1-2 days after vaccination and then again after 7 days (less intense then in the beginning). additionally, itching, swelling, rash and a dull feeling at the injection site after 7 days

Other Meds: none

Current Illness: none

ID: 1070062
Sex: F
Age: 54
State: WA

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: None yet - calle doctors to follow up

Allergies: Tomatoes Iodanted contrast Demerol Keflex Xylocaine Inapsine , Clarithromycin, Vicodin, amoxicilin, epinephrine

Symptoms: Rash, hives, swelling face, mouth tongue, nose, ears, eyes. Beet red face. Blood pressure normally low 110/70 but went from 166/86 at 1333 HR 80 02 100%, then BP 163/88 at 1404 HR 74 02 100%, then at 1409 HR 68 BP 175/110 RR24 O2 100% 1405 - 911 called took benadryll at 1330 (25 mg) then again 1349 took 2nd dose of benadryll 25 mg liquid capsules. PT has adverse reactions to epinephrine. 1412 tongue swelling. by 330 pm patient went home prepared to go to ER if anything changed. She walked around in cool air and had hives move around her body. Not shot in upper right arm. It was tasted during injection. Then after the shot reactions kicked in at 20 minutes moving up the right side primarily same as shot side. Arms, chest, and face flush off and on. Swelling moved around.

Other Meds: None - normally I take Align pro biotic, Heathers fiber pm, gummy vitamins, Vit D liquid, magnesium and calcium liquid but I skipped it the day before and the day of the shot.

Current Illness: None - healthy overall high BMI over 30

ID: 1070063
Sex: F
Age: 40
State: CA

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: 3/2- Covid and flu test both came back negative

Allergies: None

Symptoms: Dizzy Friday when given shot, Chills and fever Friday night, upset stomach, headache, low grade fever on Saturday, upset stomach, headache, lowgrade fever on Sunday, Swollen lymph nodes, rash on chest/shoulders/upper back and chills Monday, Rash spread to torso, arms, legs and neck, eyes burned and left ear hurt, chills, fever was 104, resting hear rate was 120 bpm

Other Meds: Bactrim

Current Illness: unknown lump in breast, acne

ID: 1070065
Sex: M
Age: 72
State: VT

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: N/A

Allergies:

Symptoms: 1140 - Pt states experiencing dizziness and "neck tightness" - clarified this is outside of the throat - and warmth over bilat shoulders post vaccine. Began in observation area within 5 minutes of receiving vax (admin time at 11:3. Pt states has a h/o significant back pain and balance issues including multiple surgeries, and is currently being evaluated for similar episodes. Thinks contributing factors include 20 min wait in car (sitting) for appt time, and long ramp incline at clinic entrance. 1141 -Pt taken to first aid area via WC. Offered water (refused). VS: BP - 160/78, P 69, O2 sat 98-99%, RR 14. Appears calm, AAOx3 - no s/o erythema, diaphoresis, edema Denies SOB, dyspnea, urticaria, nausea, CP 1150 - Pt states dizziness resolved. Fells "at his baseline. VS: BP - 158/76, P - 69, O2 sat 98% Call to Pts wife at home. Feels well enough to drive. Observed to car

Other Meds:

Current Illness:

ID: 1070066
Sex: F
Age: 33
State: AZ

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Penicillin, Ceftriaxone

Symptoms: Occured at off site vaccination clinic. About 15 minutes after vaccination patient complained about itchy throat. Gave patient diphenhydramine 25mg capsule and bottle of water. Called nurse to check pulse and blood pressure, both normal. About 5 minutes later she said the sensation felt worse. Gave her diphenhydramine 25mg liquid dose. Nurse called for Emergency Services prepared to administer Epi-pen if needed (was not used). Patient felt she may be getting short of breath. EMS showed up at that time and took over. They checked patients throat and she said she thought the shortness of breath was getting worse so they decided to transport her to the ER.

Other Meds: Losartan, Fluconazole, Metronidazole, Prenatal Vitamins, Cholecalciferol

Current Illness:

ID: 1070067
Sex: F
Age: 48
State: VA

Vax Date: 02/23/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: A large welt has swollen up at the shot site on my arm. It is hot and itchy. Looks like a giant hive. It has been slightly tender since the shot a week ago but swelling just occurred today.

Other Meds:

Current Illness:

ID: 1070068
Sex: F
Age: 68
State: CA

Vax Date: 01/30/2021
Onset Date: 02/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Glucophage - Nausea/vomiting Percocet - Headache

Symptoms: Bell's Palsy per emergency department. Per ED note: "She states initially she had some sore left arm that got very sore by Saturday night but then she awakened with facial numbness on Sunday she describes it as an inflamed feeling as if she is seen at at the dentist initially started on the right then went to the left by Sunday night she had bilateral facial numbness and today however it is only on the left side. She describes difficulty closing her left eye by last night and difficulty drinking and she drools." Treated with Prednisone .

Other Meds: MiraLax 17 GM, Oscal 500/200 D-3 500-200 MG-UNIT, Fosamax 70 MG, Fish Oil 1000 MG Simvastatin 10 mg Amlodipine Besylate 5 MG

Current Illness:

ID: 1070069
Sex: F
Age: 32
State: TX

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Hydrocortisone

Symptoms: joint pain Chills Fever Body aches Lung pain

Other Meds: Multivitamin, Vitamin D, birth control

Current Illness: None

ID: 1070070
Sex: F
Age: 52
State: MN

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: She did have an x-ay of this area done as she was seeing a provider for an xray of her lower extremities due to a previous car accident many years ago.

Allergies: Erythromycin and amoxicillin Spironolactione

Symptoms: Patient describes the event as her arm being very sore that also radiates into her left clavicle area and into her neck region.

Other Meds: Provigil, Lexapro, Lisinopril, ASA 81mg, Doxycycline

Current Illness: None

ID: 1070071
Sex: M
Age: 65
State: RI

Vax Date: 02/13/2021
Onset Date: 02/19/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: none

Symptoms: Significant Swelling at injection site, approx the size of my palm or width and hight of 4 fingers. also redness and slight rash, slightly warm to touch. the swelling was easy to see standing in mirror looking at both arms, mild pain, no fever, I noticed this about 6 days after injection. and it lasted about a week. no treatment needed.

Other Meds: private

Current Illness: none

ID: 1070072
Sex: M
Age: 28
State: NY

Vax Date: 02/26/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Codiene

Symptoms: Chills and Muscle aches in neck, shoulders, and arms.

Other Meds: Escitalopram 20 mg Buproprion 150 mp Zafirlukast 40 mg

Current Illness:

ID: 1070073
Sex: F
Age: 76
State: NE

Vax Date: 02/26/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data: Did not seek medical advice

Allergies: prednisone

Symptoms: Rash on the back of my neck that appeared 3 days after vaccine. Looks like the pictures that show the arm, but my rash is on the back of

Other Meds: none

Current Illness: none

ID: 1070074
Sex: F
Age: 41
State: CA

Vax Date: 03/01/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies: Possible shell fish allergy Possible allergy to glue from lash extensions

Symptoms: Red splotchy rash on torso. From neck to lower stomach

Other Meds: Ortho tri cyclen Effexor Daily vitamin Vitamin D Immunity support supplement

Current Illness: None

ID: 1070483
Sex: F
Age: 38
State: IL

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: The patient complained of burning and the administration was stopped. The patient received only 0.2 mL of the dose.; She got MMR-II yesterday, about 0.25 ml / The patient received only 0.2 mL of the dose.; This spontaneous report was received from a pharmacist referring to a 38-year-old female patient (conflicting information, also reported as "male"). Information regarding the patient's pertinent medical history, concurrent conditions, concomitant medications, and previous drug reactions or allergies was unknown. On 19-FEB-2021, the patient had to received once a dose of 0.5 milliliter (ml) injected of measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (rHA) (M-M-R II) (strength, vaccination scheme frequency, exact route of administration, and anatomical location were not reported; lot number reported as T007232, had been verified to be a valid lot number, expiration date reported and upon internal validation established as 27-FEB-2022) as immunization, however, the pharmacist stated that approximately 0.25 ml of the vaccine dose remained in the syringe (conflicting information, also reported that "the patient received only 0.2 ml of the dose") (incorrect dose administered), because the patient informed the healthcare provider who administered the vaccine that it was burning (vaccination site pain), and so the needle was pulled out. Additionally, it was unknown if the patient will receive the remainder of the measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (rHA) (M-M-R II) and it was reported that the patient needed varicella virus vaccine live (Oka/Merck) (VARIVAX) but she could not wait 28 days for varicella virus vaccine live (Oka/Merck) (VARIVAX) because she would be out of the country. It was unknown if the patient received treatment for the adverse event, if laboratory diagnostics or studies were performed, or if the patient sought medical attention. The outcome of the event vaccination site pain was unknown. The reporter considered the event vaccination site pain to be related to measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (rHA) (M-M-R II).

Other Meds:

Current Illness:

ID: 1070484
Sex: U
Age:
State: SC

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: No additional adverse effect reported.; Caller reported that PROQUAD that went out of range was administered.; This spontaneous report was received from a nurse referring to a patient of unknown age and gender. Information about patient's pertinent concurrent conditions, medical history, concomitant medications and previous drug reactions or allergies was not provided. On 25-FEB-2021, the patient was vaccinated with measles, mumps, rubella and varicella (oka-merck) virus vaccine live (recombinant human albumin) (PROQUAD) as prophylaxis (concentration, number of administered dose, dosage, vaccination scheme frequency, route of administration and anatomical location were not reported; lot number T027115 has been verified to be a valid lot number for measles, mumps, rubella and varicella (oka-merck) virus vaccine live, expiration date reported as 07-FEB-2022). No adverse effects were reported for the patient. According to the reporter, the temperature excursion was -10 degrees Celsius to 8 degrees Celsius (-3.7 degrees Celsius) for a time frame of 22 hours on an unspecified date (product storage error), without any previous temperature excursion; which was detected by a digital data logger.

Other Meds:

Current Illness:

ID: 1070485
Sex: U
Age:
State: IN

Vax Date:
Onset Date:
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: arm pain; This case was reported by a consumer via call center representative and described the occurrence of pain in arm in a 51-year-old patient who received Herpes zoster (Shingrix) for prophylaxis. On an unknown date, the patient received the 1st dose of Shingrix. On an unknown date, unknown after receiving Shingrix, the patient experienced pain in arm. On an unknown date, the outcome of the pain in arm was recovered/resolved. It was unknown if the reporter considered the pain in arm to be related to Shingrix. Additional details were provided as follows: The age at vaccination was not reported. After receiving 1st dose of Shingrix, the patient experienced pain in arm. For tolerance with 2nd dose of Shingrix, refer linked case US2021AMR028893.; Sender's Comments: US-GLAXOSMITHKLINE-US2021AMR028893:same reporter

Other Meds:

Current Illness:

ID: 1070486
Sex: F
Age: 79
State: NY

Vax Date: 09/09/2020
Onset Date: 09/30/2020
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: painat the injection sight which was her left arm; swelling at the injection sight which was her left arm; redness at the injection sight which was her left arm; got shingles after first shot; blisters on arms, neck, back and chest; This case was reported by a consumer via call center representative and described the occurrence of shingles in a 79-year-old female patient who received Herpes zoster (Shingrix) for prophylaxis. On 9th September 2020, the patient received the 1st dose of Shingrix (intramuscular). On 30th September 2020, 21 days after receiving Shingrix, the patient experienced shingles and blister. On an unknown date, the patient experienced injection site pain, injection site swelling and injection site erythema. On an unknown date, the outcome of the shingles and blister were unknown and the outcome of the injection site pain, injection site swelling and injection site erythema were recovered/resolved. It was unknown if the reporter considered the shingles, blister, injection site pain, injection site swelling and injection site erythema to be related to Shingrix. Additional details were reported as follows: The patient did not have Lot number on the information pharmacy provided or strength. The patient experinced shingles. The three weeks later patient developed blisters on arms, neck, back and chest. The patient experienced pain, redness and swelling at the injection sight which was her left arm. The patient stated that the swelling and pain subsided but the redness stayed for months. The reporter given permission to follow up with HCP (healthcare professional). The reporter consented to follow up.

Other Meds:

Current Illness:

ID: 1070487
Sex: F
Age: 78
State: CA

Vax Date: 11/01/2019
Onset Date: 01/01/2020
Rec V Date: 03/03/2021
Hospital:

Lab Data: Test Date: 202001; Test Name: Vitamin B12 increased; Result Unstructured Data: (Test Result:high level in blood,Unit:unknown,Normal Low:,Normal High:)

Allergies:

Symptoms: Experiencing pain that alternated from the left hip, to the left knee, to the right hip, to the right knee / return of a previous pain in the left shoulder; Hair ceased growing / has only grown one inch since last dose received; Temporary bubble in the left eye; Low blood pressure; Dizziness; Hard lumps have formed on the top of the skin over their knuckles; Being unable to walk for approximately 1 week; Unable to chew for approximately 1 week; This case was reported by a consumer via call center representative and described the occurrence of unable to walk in a 78-year-old female patient who received HBV (Engerix B) for prophylaxis. The patient's past medical history included shoulder pain. Previously administered products included Engerix B (1st dose received on May 2019) and Engerix B (2nd dose received on June 2019). In November 2019, the patient received the 3rd dose of Engerix B. In January 2020, 2 months after receiving Engerix B, the patient experienced unable to walk, chewing difficulty, arthralgia multiple, hair growth decreased, eye disorder, low blood pressure, dizziness and skin nodule. On an unknown date, the outcome of the unable to walk, chewing difficulty, eye disorder, low blood pressure and dizziness were recovered/resolved and the outcome of the arthralgia multiple was recovering/resolving and the outcome of the hair growth decreased and skin nodule were not recovered/not resolved. It was unknown if the reporter considered the unable to walk, chewing difficulty, arthralgia multiple, hair growth decreased, eye disorder, low blood pressure, dizziness and skin nodule to be related to Engerix B. Additional details were provided as follows: The reporter was the patient. The blood tests had showed high level of B12 in the blood. The patient had received all the three doses of Engerix B. The patient had onset of symptoms as approximately 2 months after receiving last dose. The patient was unable to walk and unable to chew for approximately 1 week. The patient was experiencing pain that alternated from the left hip, to the left knee, to the right hip, to the right knee. The patient stated that there was a return of a previous pain in the left shoulder Hair had ceased growing after receiving last dose of vaccine and had only grown one inch since the last dose. The patient reported an appearance of a temporary bubble in the left eye. The patient had also experienced low blood pressure that resulted in dizziness. The patient also had hard lumps that had formed on the top of the skin over the knuckles. The reporter did not consent to follow-up.

Other Meds:

Current Illness:

ID: 1070488
Sex: F
Age: 71
State: WI

Vax Date: 02/04/2021
Onset Date: 02/13/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: Bell's Palsy; A spontaneous report was received from a Consumer regarding his wife who received the first dose of Moderna Covid-19 vaccine and have experienced Bell's palsy. The patient's medical history was not provided. Her concomitant medication is thyroxine. No information on allergies. On 04-FEB-2021, prior to the onset of events, the patient received first of two planned doses of Covid-19 vaccine intramuscularly for the prophylaxis of Covid-19 infection. On 11-FEB-2021, patient noticed excessive watering from her right eye, next day on 12-FEB-2021, she felt jaw pain on right side of her mouth and her lip began to droop. On13-FEB-2021, patient was taken to ER where she was diagnosed with Bell's Palsy. She was treated with antivirals and steroids. She is recovering, but still side effects are present. Action taken with the 2nd dose of vaccine was not reported. The outcome of the event Bell's Palsy is still recovering at the time of report.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Very limited information regarding this event has been provided at this time.

Other Meds: THYROXINE

Current Illness:

ID: 1070489
Sex: F
Age:
State: TX

Vax Date: 02/04/2021
Onset Date: 02/17/2021
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: UTI infection; swollen lymph nodes,hard to touch; swollen at site of injection; Headache; Fatigue; Tenderness at site of injection; A spontaneous report was received from a consumer concerning a 54 years old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced lymph nodes near neck are swollen and hard to touch, tenderness at site of injection, swollen at site of injection, Urinary tract infections, tiredness and headache. The patient's medical history was not provided. Relevant concomitant medications were reported "hidden". On 04-FEB-2021 approximately a week prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number012M2 (or 7) 0A) in left arm for prophylaxis of COVID-19 infection. On 11-FEB-2021 or 12-FEB-2021, the patient started feeling something on the left area near the neck lymph nodes swollen and hard to touch and headache. On that weekend patient experienced tenderness and swollen at injection site and tiredness. Treatment for the event included two paracetamol for pain and OTC "Quora" for Urinary tract infections on 17-FEB-2021. The outcome of the events, lymph nodes near neck are swollen and hard to touch, tenderness at site of injection, swollen at site of injection, Urinary tract infections, tiredness and headache, were unknown.; Reporter's Comments: Based on the information provided which includes a temporal association, and known safety profile of the vaccine, a causal association between the reported events of lymphadenopathy, injection site tenderness and swelling, tiredness and headache and the administration of the mRNA-1273 vaccine cannot be excluded. Urinary tract infections is assessed as unlikely related to vaccine use but due to an infection

Other Meds:

Current Illness:

ID: 1070490
Sex: F
Age: 89
State: NJ

Vax Date: 01/07/2021
Onset Date: 01/31/2021
Rec V Date: 03/03/2021
Hospital: Y

Lab Data: Test Date: 20210219; Test Name: COVID-19; Test Result: Positive ; Result Unstructured Data: COVID-19 TEST POSITIVE

Allergies:

Symptoms: Did not open eyes (Unresponsive); Not speaking; Fever; Positive COVID Test; UTI; A spontaneous report was received from a consumer concerning an 89-year-old female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced the following: did not open eyes (unresponsive)/unresponsive to stimuli, UTI (urinary tract infection), positive COVID test/SARS-CoV-2 test postive, fever (pyrexia) and not speaking (dysphasia). The patient's medical history included Parkinson's Disease. On 19-FEB-2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot/batch:unknown) intramuscularly for prophylaxis of COVID-19 infection. Treatment included antibiotics, remdesivir IV (intravenous) and rehabilitation. Action taken with mRNA-1273 in response to the events was not reported. At the time of this report, the outcome of the events did not open eyes (unresponsive), UTI, positive COVID test, fever, and not speaking was unknown.; Reporter's Comments: This case concerns an 89-year-old female who experienced serious unexpected events of COVID-19, pyrexia, urinary tract infection, aphasia, unresponsive to stimuli. The events occurred 25 days after the first dose of mRNA-1273. Treated with antibiotics and IV remdesivir. Event outcomes unknown. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds:

Current Illness: Parkinson's disease

ID: 1070491
Sex: F
Age: 50
State: TX

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 03/03/2021
Hospital: Y

Lab Data:

Allergies:

Symptoms: difficulty breathing; vision issues; cloudy and fogginess; vomiting; While in the hospital she was stated to have been on 100% oxygen, couldn't breathe at all; A spontaneous report was received from a 50-year-old female patient. The patient's medical history included Lupus, and COPD. Products known to have been used by the patient, within two weeks prior to the event, included Salbutamol Sulfate, Alprazolam, Lisinopril, Ezetimibe, and Pantoprazole Sodium Sesquihydrate. On 31 Dec-2020, prior to the onset of events, the patient received the first of two planned doses of mRNA-1273 (Lot unknown) by injection (site not provided) for prophylaxis of COVID-19 infection. On 31-Dec-2020, the patient developed difficulty breathing, vision became cloudy/foggy and vomiting. The patient spent New Year's day in the hospital (admission and discharge date and times were not provided), she was treated with 100% Oxygen, Zofran and Morphine. The patient also had nine symptoms while she was in the hospital however details were not reported. Action taken with mRNA-1273 in response to the events was unknown The outcome of the events were unknown.; Reporter's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds: INHALERIN; XANAX; LISINOPRIL; ZETIA; PROTERA [PANTOPRAZOLE SODIUM SESQUIHYDRATE]

Current Illness: COPD; Lupus pneumonitis

ID: 1070492
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: UTI; This is a spontaneous report from a contactable consumer (patient). A female patient of an unspecified age received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number and expiry date: unknown), via an unspecified route of administration on an unspecified date at a single dose for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. The patient had a UTI on an unspecified date and was prescribed Sulfamethoxazole/Trimethoprim. She read the literature on it which states to not take any vaccines, such as the typhoid vaccine while on this medication unless the doctor tells you to. Patient was asking if it was safe for her to get the second dose of the vaccine while on this medication. Outcome of the event was unknown. Information about lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1070493
Sex: M
Age:
State: NC

Vax Date: 01/29/2021
Onset Date:
Rec V Date: 03/03/2021
Hospital:

Lab Data:

Allergies:

Symptoms: pain; This is a spontaneous report from a contactable consumer (patient's wife) via a Pfizer Sponsored Program. A 70-year-old male patient received his first dose bnt162b2 (BNT162B2 reported as PFIZER-BIONTECH COVID-19 VACCINE) at unknown vaccination age via an unspecified route of administration on 29Jan2021 at a single dose for covid-19 immunization. The patient's medical history and concomitant medications were not reported. The reporter stated that the patient received the first dose of the COVID-19 vaccine last Friday (29Jan2021), and he is scheduled to receive his "pain shot" this coming Thursday (unspecified date). She asked if it is ok for her husband to receive this injection between the two doses of the vaccine. She inquired if that's okay to take it prior to the second shot. The outcome of the event was unknown. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 134,999

Page last modified: 14 December 2021 10:42pm